Intubating the combative patient

Conditions
January 11, 2011

How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.

Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …

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Common things are common, except when the diagnosis is rare

Conditions
January 7, 2011

During my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: “When you hear hoofbeats, think of horses not zebras!” He would also frequently use: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” What did my mentor, the Sage of HCMC, mean by this?

From Wikipedia: “Zebra …

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Adding tiotropium (Spiriva) to an inhaled steroid a mistake?

Meds
December 30, 2010

There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this …

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Hospital meals make it difficult to control blood sugars

Physician
December 30, 2010

My mom doesn’t take any diabetes medicine.  She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.”  The procedure went fine, but not the food.  The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …

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Your attention deficit disorder may be an anxiety disorder

Conditions
December 29, 2010

Are you one of those people who simply cannot concentrate for long enough? Do you find that no sooner than you start doing something, that your attention is scattered all over the place? Do you find that you log onto your computer and within minutes are surfing every possible tangential site that you find?

Your problem may not be a problem with your attention. In fact, it may be that the …

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Tips to find a good psychiatrist

Physician
December 29, 2010

Seems like a simple enough question: How do you find a psychiatrist?

It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.

We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your Insurance, …

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Reduce phone calls in your medical practice

Physician
December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

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Patient complaints do not fit the primary care office visit

KevinMD
December 28, 2010

Primary care physicians often have to see patients with a litany of issues.  Often within a span of a 15-minute office visit.

This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.

And, in some cases, it’s simply impossible to adequately address every patient question …

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Successful surgery rotation tips

Education
December 24, 2010

I recently finished my two months of surgery rotations.

I am happy to say that I really enjoyed my surgery rotations. I thought I was going to be intimidated by the OR, but I found it fascinating. I am relieved, since surgery is a big part of OB/GYN.

Here are a few things I learned on my surgery rotation:

  • Scrub in before the surgeon but after the OR nurse.
  • Before you scrub in, introduce …

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Everything about medicine is now big business

Policy
December 18, 2010

Med­i­cine used to be different. Doc­tors couldn’t do too much for you. They didn’t get paid very much and they were focused more on helping than on managing a business.

Hospitals were community-based not-for-profit or public entities. Drugs and devices were not as sophisticated or expensive, and they weren’t marketed directly to consumers. Well Toto, we’re not in Kansas any­more.

After witnessing our “health­care reform” process you must have seen that almost …

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The cost of keeping the terminally ill alive

Physician
December 16, 2010

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …

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A physician story of addiction and recovery

Physician
December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this …

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How to intubate: Teaching a medical student during anesthesia residency

Education
December 16, 2010

The first time I let a medical student try to intubate was in August. Now in my final year of anesthesia residency, I had volunteered to mentor a third-year medical student for a week. A few weeks in advance I got an email with the form she had filled out. Anesthesia experience: none. Excited to learn: yes.

I met her on Monday morning after she navigated through the preoperative holding area …

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Medical errors that involve handwritten prescriptions

Physician
December 14, 2010

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more …

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7 favorite ER superstitions

Physician
December 12, 2010

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Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.

1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …

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Stercoral perforation as a deadly cause of colon rupture

Physician
December 9, 2010

I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …

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William Osler’s humor, and finding fun in medicine

Physician
December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

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Priapism is indicative of spinal cord injury in trauma

Conditions
December 4, 2010

It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.

According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …

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Lifestyle matters for specialties that want to survive

KevinMD
December 2, 2010

Medical students today consider lifestyle an essential criteria when choosing a specialty.

It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands.

Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work …

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